Retaining device

ABSTRACT

A retaining device includes a first member, a second member, a third member, a support section supporting the first member and supporting the second member and the third member movably relative to the first member, and a manipulation part moving the first member, the second member, and the third member relative to each other. The first member and the third member can grasp a first tissue with the first tissue disposed between the first member and the second member and between the first member and the third member, and the first member and the second member can grasp the first tissue and a second tissue such that the second tissue is disposed between the first member and the second member and between the second member and the third member to contact with the first tissue with the first member and the third member grasping the first tissue.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a retaining device configured to retaina tissue of a living body.

This application is a continuation application based on PCT PatentApplication No. PCT/JP2014/077081, filed Oct. 9, 2014, whose priority isclaimed on Japanese Patent Application No. 2014-004638, filed Jan. 14,2014. The contents of both the PCT Patent Application and the JapanesePatent Application are incorporated herein by reference.

2. Description of Related Art

In the related art, when a wall surface or the like of a tissue of abody is largely torn or when incision is made in an operation or thelike, one side (a first tissue) and the other side (a second tissue) inthe torn area or the incision area are brought together to be sutured.Here, in many cases, suture threads pass through the first tissue andthe second tissue to be drawn to close these areas, and the tissues ofthe gap are drawn using a plurality of grasping forceps and these areasare fastened together using a clip device or a stapler device. Forexample, in Published Japanese Translation No. 2001-512703 of the PCTInternational Publication and Japanese Unexamined Patent Application,First Publication No. 2010-125200, a device configured to suture aliving body tissue is disclosed.

SUMMARY OF THE INVENTION

According to a first aspect of the present invention, a retaining deviceincludes: a first member and a second member configured to grasp a firsttissue and a second tissue disposed separate from the first tissue; athird member configured to be capable of approaching and moving awayfrom the first member and the second member; a support sectionconfigured to support the first member, support the second member so asto be movable relative to the first member such that the second memberis capable of approaching and moving away from the first member, andsupport the third member so as to be movable relative to the firstmember such that the third member is capable of approaching and movingaway from the first member; and a manipulation part connected to thesupport section and configured to manipulate the first member, thesecond member, and the third member such that the first member, thesecond member, and the third member move relative to each other. Thefirst member and the third member are capable of grasping the firsttissue in a state in which the first tissue is disposed between thefirst member and the second member, and between the first member and thethird member, and the first member and the second member are capable ofgrasping the first tissue and the second tissue such that the secondtissue is disposed between the first member and the second member, andbetween the second member and the third member to bring the first tissueand the second tissue in contact with each other in a state in which thefirst member and the third member grasp the first tissue.

According to a second aspect of the present invention, the retainingdevice according to the first aspect of the present invention mayfurther include: a tissue fastening tool having a first piece and asecond piece configured to pinch the first tissue and the second tissuebetween the first member and the second member, the tissue fasteningtool being configured to be implanted in a living body; a firstconnecting section configured to connect the first piece and the firstmember such that the first piece is disposed at a side of the secondmember on an outer surface of the first member; and a second connectingsection configured to connect the second piece and the second membersuch that the second piece is disposed at a side of the first member onan outer surface of the second member.

According to a third aspect of the present invention, in the retainingdevice according to the second aspect of the present invention, themanipulation part may have a switching part configured to switch aconnected state in which the first piece is connected to the firstconnecting section and the second piece is connected to the secondconnecting section, and a released state in which the first piece isspaced apart from the first connecting section and the second piece isspaced apart from the second connecting section.

According to a fourth aspect of the present invention, in the retainingdevice according to the first aspect of the present invention, the thirdmember may be disposed at a position separate from positions of thefirst member and the second member in a direction perpendicular to adirection in which the first member approaches or moves away from thesecond member.

According to a fifth aspect of the present invention, in the retainingdevice according to the first aspect of the present invention, thesupport section may be configured to support the third member such thatthe third member moves away from the second member as the third memberapproaches the first member.

According to a sixth aspect of the present invention, in the retainingdevice according to the first aspect of the present invention, thesupport section may have: a first opening/closing section configured tosupport the first member and the second member such that the firstmember and the second member are capable of moving relative to eachother such that a moving direction of the second member with respect tothe first member becomes reciprocation movement in one predeterminedplane; and a second opening/closing section configured to support thethird member such that the third member is capable of moving relative tothe first member such that an abutting direction of the third memberwith the first member becomes a direction along a surface crossing theone plane.

According to a seventh aspect of the present invention, in the retainingdevice according to the sixth aspect of the present invention, thesecond opening/closing section may reciprocate the third member betweena position at which the third member is adjacent to the second memberand a position at which the third member is adjacent to the firstmember.

According to an eighth aspect of the present invention, in the retainingdevice according to the seventh aspect of the present invention, thesupport section may include: a first support body having a rod shape andconfigured to support the first member and the second member; and asecond support body formed in a tubular shape through which the firstsupport body is inserted, and configured to be rotatable with respect tothe first support body about a centerline of the first support bodyserving as a rotational center, the third member being fixed to thesecond support body. The second opening/closing section may reciprocatethe third member between the position at which the third member isadjacent to the second member and the position at which the third memberis adjacent to the first member along a circumference about thecenterline of the first support body serving as a rotational center by arotational motion of the second support body with respect to the firstsupport body.

According to a ninth aspect of the present invention, in the retainingdevice according to the sixth aspect of the present invention, thesecond opening/closing section may linearly move the third memberrelative to the first member.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of a retaining device according to a firstembodiment of the present invention.

FIG. 2 is a plan view showing an example of a tissue fastening tool thatcan be attached to the retaining device according to the firstembodiment and used.

FIG. 3 is a schematic view showing a tissue fastening state using thetissue fastening tool.

FIG. 4 is a partial cross-sectional view showing a configuration of aportion of the retaining device according to the first embodiment.

FIG. 5 is a front view of the retaining device.

FIG. 6 is a front view showing a state in which the tissue fasteningtool is attached to the retaining device.

FIG. 7 is a view of a treatment section of the retaining device whenseen from above.

FIG. 8 is a view showing a state in which the tissue fastening tool isattached to the retaining device when seen from above.

FIG. 9 is a view for describing an action of the retaining device.

FIG. 10 is a view for describing an action of the retaining device.

FIG. 11 is a view showing a process of a tissue fastening procedureusing the retaining device.

FIG. 12 is a view showing a process of the tissue fastening procedureusing the retaining device.

FIG. 13 is a view showing a process of the tissue fastening procedureusing the retaining device.

FIG. 14 is a view showing a process of the tissue fastening procedureusing the retaining device.

FIG. 15 is a schematic view showing a state in which the tissuefastening tool fastens a tissue.

FIG. 16 is a perspective view showing a configuration of a modifiedexample of the first embodiment.

FIG. 17 is a partial cross-sectional view showing a retaining deviceaccording to a second embodiment of the present invention.

FIG. 18 is a front view of the retaining device according to the secondembodiment.

FIG. 19 is a front view showing a configuration of a modified example ofthe second embodiment.

FIG. 20 is a front view showing another configuration of the modifiedexample of the second embodiment.

FIG. 21 is a front view showing still another configuration of themodified example of the second embodiment.

DETAILED DESCRIPTION OF THE INVENTION First Embodiment

A first embodiment of the present invention will be described. FIG. 1 isa side view of a retaining device according to the embodiment. Aretaining device 1 according to the embodiment shown in FIG. 1 is adevice configured to retain a first tissue T1 and a second tissue T2(see FIG. 3) of a living body in a state in which the tissues areadjacent to each other. In the embodiment, the first tissue T1 and thesecond tissue T2 may be different internal organs, may be two placesspaced apart from each other due to an injury in an internal organhaving an incision wound or a laceration, or may be two places spacedapart from each other in a normal tissue. Hereinafter, as the firsttissue T1 and the second tissue T2, the two places spaced apart fromeach other by an incision in an operation will be exemplarily described.

First, a configuration of a tissue fastening tool 30 according to theembodiment configured to fasten together the first tissue T1 and thesecond tissue T2 will be described. FIG. 2 is a plan view showing anexample of the tissue fastening tool that can be attached to theretaining device according to the embodiment and used. FIG. 3 is aschematic view showing a tissue fastening state using the tissuefastening tool.

The tissue fastening tool 30 shown in FIG. 2 is formed in a U shape andcan be plastically deformed. The tissue fastening tool 30 is constitutedby, for example, a metal. The tissue fastening tool 30 has a first piece31 configured to come in contact with the first tissue T1 when the firsttissue T1 and the second tissue T2 are fastened together, and a secondpiece 32 configured to come in contact with the second tissue T2 whenthe first tissue T1 and the second tissue T2 are fastened together. Anend portion of the first piece 31 and an end portion of the second piece32 are linked together. That is, the tissue fastening tool 30 pinchesboth of the first tissue T1 and the second tissue T2 as shown in FIG. 3as the first piece 31 and the second piece 32 are closed in a state inwhich the first tissue T1 and the second tissue T2 are inserted betweenthe first piece 31 and the second piece 32, and retains the first tissueT1 and the second tissue T2 in a state in which the first tissue T1 andthe second tissue T2 come in contact with each other. The first tissueT1 and the second tissue T2 retained by the tissue fastening tool 30according to the embodiment are conglutinated in the contact portionthereof.

Next, a configuration of the retaining device 1 according to theembodiment will be described. FIG. 4 is a partial cross-sectional viewshowing a configuration of a portion of the retaining device accordingto the embodiment. FIG. 5 is a front view of the retaining device. FIG.6 is a front view showing a state in which the tissue fastening tool isattached to the retaining device. FIG. 7 is a view of a treatmentsection of the retaining device when seen from above. FIG. 8 is a viewshowing a state in which the tissue fastening tool is attached to theretaining device when seen from above.

As shown in FIG. 1, the retaining device 1 includes a rod-shapedinsertion section 2 that can be inserted into a body, a treatmentsection 10 provided at a distal end of the insertion section 2, and amanipulation part 20 provided at a proximal end of the insertion section2.

As shown in FIG. 4, the insertion section 2 includes an inner tubeportion 3 (a first support body), an outer tube portion 4 (a secondsupport body), and a transmission portion 5 disposed in the inner tubeportion 3.

The inner tube portion 3 is an elongated rigid member. The material ofthe inner tube portion 3 may be, for example, a resin, a metal, or thelike.

The outer tube portion 4 is an elongated rigid member having an innerdiameter larger than an outer diameter of the inner tube portion 3. Amaterial of the outer tube portion 4 may be, for example, a resin, ametal, or the like. A finger member 14 (a third member) is fixed to adistal end of the outer tube portion 4. The finger member 14 is arod-shaped member extending parallel to a centerline of the outer tubeportion 4. That is, the distal end of the outer tube portion 4 becomes asupport section configured to support the finger member 14. A proximalend of the outer tube portion 4 is disposed in the vicinity of themanipulation part 20. In a state in which the inner tube portion 3 isdisposed in the outer tube portion 4, the centerline of the outer tubeportion 4 and a centerline of the inner tube portion 3 substantiallycoincide with each other. For this reason, the outer tube portion 4 isrotatable with respect to the inner tube portion 3 about the centerlineof the inner tube portion 3 serving as a rotational center.

The transmission portion 5 is disposed in the inner tube portion 3 totransmit the manipulation of implanting the tissue fastening tool 30 ina living body tissue from the manipulation part 20 to the treatmentsection 10. The transmission portion 5 has a connecting rod 6 having adistal end fixed to a link section 15 (to be described below) in thetreatment section 10 and a proximal end disposed at the manipulationpart 20.

As shown in FIGS. 4 and 5, the treatment section 10 includes a pair ofjaws 11 (a first member 12 and a second member 13) configured to implantthe tissue fastening tool 30 in the living body tissue, theabove-mentioned finger member 14 (the third member) fixed to the distalend of the outer tube portion 4, and the link section 15 (a supportsection, a first opening/closing section) configured to support the pairof jaws 11 to be opened/closed. The pair of jaws 11 can be opened andclosed by the link section 15. As shown in FIGS. 6 and 8, the tissuefastening tool 30 can be attached between the pair of jaws 11.

As shown in FIGS. 7 and 8, the first member 12 is formed insubstantially a rod shape. A proximal end of the first member 12 isattached to the link section 15. The first member 12 has a firstconnecting section 12 a configured to connect with the first piece 31 ofthe tissue fastening tool 30. The first connecting section 12 aaccording to the embodiment is a surface directed toward the secondmember 13 among the outer surfaces of the first member 12.

The second member 13 is formed in substantially a rod shape. A proximalend of the second member 13 is attached to the link section 15. Thesecond member 13 has a second connecting section 13 a configured toconnect with the second piece 32 of the tissue fastening tool 30. Thesecond connecting section 13 a according to the embodiment is a surfacedirected toward the first member 12 among the outer surfaces of thesecond member 13.

An interval between the first member 12 and the second member 13 definesa distance between the first piece 31 and the second piece 32 of thetissue fastening tool 30 in a state in which the first piece 31 isconnected to the first connecting section 12 a and the second piece 32is connected to the second connecting section 13 a (hereinafter referredto as “a connected state”). That is, when the first connecting section12 a and the second connecting section 13 a move relative to each othersuch that the first connecting section 12 a and the second connectingsection 13 a approach each other, the first piece 31 and the secondpiece 32 of the tissue fastening tool 30 approach each other, and thetissue fastening tool 30 is closed to retain the living body tissue. Inaddition, when the first member 12 and the second member 13 move awayfrom each other after the tissue fastening tool 30 in the connectedstate is closed, as the first piece 31 moves away from the firstconnecting section 12 a and the second piece 32 moves away from thesecond connecting section 13 a, the tissue fastening tool 30 is releasedfrom the first member 12 and the second member 13 (hereinafter referredto as “a released state”).

The link section 15 shown in FIG. 4 supports the first member 12 and thesecond member 13 such that the first member 12 and the second member 13are opened and closed (see FIG. 7). The link section 15 is connected toa distal end of the connecting rod 6 of the transmission portion 5. Thelink section 15 converts linear movement of the connecting rod 6 intoopening/closing movement between the first member 12 and the secondmember 13 when the connecting rod 6 moves in a centerline direction ofthe inner tube portion 3 in the inner tube portion 3.

The manipulation part 20 shown in FIG. 1 includes a lever 21 (see FIG.4) connected to the proximal end of the connecting rod 6 to open/closethe first member 12 and the second member 13, and a manipulation mainbody section 22 having a grip 23 that can be grasped by an operatortogether with the lever 21. That is, the manipulation part 20 isconnected to the link section 15 via the connecting rod 6. The lever 21functions as a switching part configured to switch the connected stateand the released state of the tissue fastening tool 30 with respect tothe first member 12 and the second member 13 by switching anopening/closing state between the first member 12 and the second member13.

In addition, in the embodiment, the proximal end of the outer tubeportion 4 is disposed in the vicinity of the boundary portion betweenthe manipulation part 20 and the insertion section 2. The proximalportion of the outer tube portion 4 is a portion that can be manipulatedby the operator to rotate the outer tube portion 4 about the centerlinethereof serving as a rotational center.

Next, an action of the retaining device 1 according to the embodimentwill be described. FIGS. 9 and 10 are views for describing the action ofthe retaining device according to the embodiment. The retaining device 1according to the embodiment can open and close the first member 12 andthe second member 13 by moving the lever 21 shown in FIG. 4. For thisreason, the tissue fastening tool 30 disposed between the first member12 and the second member 13 can be closed by moving the lever 21. Inaddition, the retaining device 1 according to the embodiment can rotatethe finger member 14 fixed to the distal end of the outer tube portion 4about the centerline of the inner tube portion 3 serving as a rotationalcenter by rotating the outer tube portion 4 with respect to the innertube portion 3 about the centerline of the inner tube portion 3 servingas a rotational center as shown in FIGS. 9 and 10, independently fromthe opening/closing motion of the first member 12 and the second member13.

Since the centerline of the outer tube portion 4 and the centerline ofthe inner tube portion 3 substantially coincide with each other, theouter tube portion 4 rotates about the centerline of the outer tubeportion 4. As the outer tube portion 4 rotates about the centerlinethereof serving as a rotational center, the finger member 14 rotatesabout the centerline of the outer tube portion 4 serving as a rotationalcenter together with the outer tube portion 4, and abuts the firstmember 12. That is, the distal portion of the tube member moves thefinger member 14 along a circumference about the centerline of the outertube portion 4 and the centerline of the inner tube portion 3 concentrictherewith that serve as a rotational center by rotating the outer tubeportion 4 with respect to the inner tube portion 3. An abuttingdirection of the finger member 14 with the first member 12 is adirection along a surface crossing a plane in which the opening/closingmotion of the first member 12 and the second member 13 is performed.

The distal portion of the outer tube portion 4 functions as a secondopening/closing section configured to open and close the finger member14 and the first member 12.

The second opening/closing section can reciprocate the finger member 14between a position at which the finger member 14 is close to the secondmember 13 and a position at which the finger member 14 is close to thefirst member 12. Accordingly, the operator can sandwich the tissuebetween the first member 12 and the finger member 14, and can sandwichthe tissue between the second member 13 and the finger member 14.

Next, an action and an effect of the retaining device 1 according to theembodiment will be described in detail by exemplarily showing aprocedure using the retaining device 1 according to the embodiment.FIGS. 11 to 14 are views showing a process of a tissue fasteningprocedure using the retaining device according to the embodiment. FIG.15 is a schematic view showing a state in which the tissue fasteningtool fastens the tissue.

In the embodiment, as the first tissue T1 and the second tissue T2 (seeFIG. 3) fastened by the tissue fastening tool 30, two places formed tobe spaced apart from each other by incision of the operation will beexemplarily described. Such fastening may be, for example, a procedureof closing the mesentery, closing of a stapler insertion port inintestinal anastomosis, temporary fastening in intestinal anastomosis,or the like. Hereinafter, an example of closing the mesentery incisedduring an operation is shown.

In use of the retaining device 1 according to the embodiment, forexample, when the mesentery is closed, the insertion section 2 isinserted into the abdominal cavity through a trocar (not shown) attachedto the abdominal wall. The treatment section 10 disposed at the distalend of the insertion section 2 is guided to an area to be closed bymanipulation of the operator.

In the incision portion of the mesentery, first, the treatment section10 is guided to one of the two places serving as the fastening target.Here, in the embodiment, as shown in FIG. 11, the outer tube portion 4is positioned with respect to the inner tube portion 3 such that thefinger member 14 is disposed between the first member 12 and the secondmember 13 or the finger member 14 comes in contact with the secondmember 13. Accordingly, a gap into which to insert the tissue (the firsttissue T1) of the mesentery is generated between the first member 12 andthe finger member 14.

The operator moves the finger member 14 with respect to the first member12 such that the finger member 14 approaches the first member 12 byinserting the first tissue T1 between the first member 12 and the fingermember 14 and rotating the outer tube portion 4 with respect to theinner tube portion 3 as shown in FIG. 12. Accordingly, the first tissueT1 is grasped by the first member 12 and the finger member 14. Here, thefirst tissue T1 comes in contact with the first piece 31 of the tissuefastening tool 30 connected to the first connecting section 12 a of thefirst member 12.

After the first tissue T1 is grasped by the treatment section 10 asdescribed above, subsequently, the operator moves the treatment section10 toward the other side (the second tissue T2) of the tissue serving asthe closing target while maintaining a state in which the first tissueT1 is grasped between the first member 12 and the finger member 14. Asthe operator moves the treatment section 10, the first tissue T1 graspedby the treatment section 10 is drawn to the second tissue T2 (see FIG.13).

After the first tissue T1 is drawn to a place at which the first tissueT1 comes in contact with the second tissue T2, the operator inserts thesecond tissue T2 between the first member 12 and the second member 13 asshown in FIG. 13 while maintaining a state in which the first member 12and the finger member 14 grasp the first tissue T1. Accordingly, thesecond tissue T2 has a positional relation that the second tissue T2 cancome in direct contact with the first tissue T1, and can come in contactwith the second piece 32 of the tissue fastening tool 30 disposed at thesecond connecting section 13 a.

The operator manipulates the lever 21 shown in FIG. 1 to close the firstmember 12 and the second member 13 while maintaining a state in whichthe first member 12 and the finger member 14 grasp the first tissue T1.The retaining device 1 retains both of the first tissue T1 and thesecond tissue T2 in a state in which the first tissue T1 and the secondtissue T2 are brought in contact with each other by the pair of jaws 11as shown in FIG. 14. Further, the first member 12 and the second member13 plastically deform the tissue fastening tool 30 such that the firstpiece 31 and the second piece 32 of the tissue fastening tool 30approach each other. That is, the first member 12 and the second member13 plastically deform the tissue fastening tool 30 such that the tissuefastening tool 30 fastens together the first tissue T1 and the secondtissue T2 while pinching the tissues T1 and T2.

The first tissue T1 and the second tissue T2 are retained in a state inwhich the first tissue T1 and the second tissue T2 are brought in directcontact with each other by the plastically deformed tissue fasteningtool 30. The operator manipulates the lever 21 to open the first member12 and the second member 13. Accordingly, the tissue fastening tool 30is released from the first connecting section 12 a of the first member12 and the second connecting section 13 a of the second member 13.Accordingly, as shown in FIG. 15, the tissue fastening tool 30 isimplanted in the mesentery such that the first tissue T1 and the secondtissue T2 of the mesentery serving as the closing target are closed. Asnecessary, a plurality of tissue fastening tools 30 may be used tofasten the tissue together.

Since the tissue fastening tool 30 fastens together the first tissue T1and the second tissue T2 in a state in which the first tissue T1 and thesecond tissue T2 are in direct contact with each other, the first tissueT1 and the second tissue T2 are gradually conglutinated using a contactportion between the first tissue T1 and the second tissue T2 as astarting point. Accordingly, the incised mesentery is closed.

The procedure of closing the mesentery is performed, for example, when aportion of the intestines is excised, when a portion of the mesenteryitself is excised, or when a gastric bypass operation is performed.However, the suture of the related art requires a complicated sequenceto simultaneously perform a motion of drawing a portion serving as asuture target and a motion of suturing a tissue while retaining thedrawn portion. In addition, for example, in an obesity operation, sincethe abdominal wall of a patient is thick, it may be difficult to securea wide space in the body when the medical device including the retainingdevice 1 according to the embodiment is used.

In the retaining device 1 according to the embodiment, the first tissueT1 and the second tissue T2 are grasped, both of the first tissue T1 andthe second tissue T2 can be retained in a state in which the firsttissue T1 and the second tissue T2 are in contact with each other, then,the first tissue T1 and the second tissue T2 can be fastened together bythe tissue fastening tool 30, and the tissue fastening tool 30 can beimplanted in the body. For this reason, in comparison with the case inwhich both of the medical device configured to grasp the tissue and theclip device configured to fasten the tissue are introduced into thebody, the procedure can be conveniently and rapidly preformed even in anarrow space.

In addition to the fact that the finger member 14 can reciprocate withrespect to the first member 12 until the finger member 14 comes incontact with the first member 12, the finger member 14 can reciprocatewith respect to the second member 13 until the finger member 14 comes incontact with the second member 13. For this reason, in the tissueserving as the closing target, even if any one of the first tissue T1and the second tissue T2 is grasped first, the procedure can be smoothlyperformed until the first tissue T1 and the second tissue T2 arefastened together. Further, since the retaining device 1 according tothe embodiment includes the treatment section 10 having a symmetricalstructure, the tissue can be grasped and fastened together regardless ofthe handedness of the operator or the approach direction of theretaining device 1.

Since the second tissue T2 can be inserted between the first member 12and the second member 13 while maintaining a state in which the firsttissue T1 is grasped between the first member 12 and the finger member14, the fastening position between the first tissue T1 and the secondtissue T2 can be easily adjusted and modified.

In the embodiment, since the tissue fastening tool 30 pinches andfastens together both of the first tissue T1 and the second tissue T2such that the first tissue T1 and the second tissue T2 come in directcontact with each other, conglutination between the first tissue T1 andthe second tissue T2 is faster than when another member is disposedbetween the first tissue T1 and the second tissue T2.

Since the finger member 14 can be moved by rotating the outer tubeportion 4 with respect to the inner tube portion 3, a manipulation forcecan be effectively transmitted to the finger member 14 using a simpleconfiguration.

MODIFIED EXAMPLE 1-1

Next, a modified example of the first embodiment will be described. FIG.16 is a perspective view showing a configuration of a modified exampleof the embodiment. As shown in FIG. 16, a retaining device 1A of themodified example is a device that can be attached to a known clip device40. The retaining device 1A includes an outer tube portion 4A having atubular shape through which an insertion body 41 inserted into the bodyin the clip device 40 can be inserted, and a finger member 14A providedat a distal end of the outer tube portion 4A. In addition, a stopperconfigured to define a positional relation between jaws 42 and 43 of theclip device 40 in the centerline direction of the insertion body 41 ofthe clip device 40 and the finger member 14A of the retaining device 1Aof the modified example may be provided at the distal end of the outertube portion 4A.

In the modified example, the retaining device 1A of the modified exampleis attached to the known clip device 40, and thus can perform the sameprocedure as the retaining device 1 described in the first embodiment.In addition, the retaining device 1A can be removed from the clip device40 when the grasping of the tissue using the finger member 14A is notneeded.

Second Embodiment

Next, a second embodiment of the present invention will be described.FIG. 17 is a partial cross-sectional view showing a retaining deviceaccording to the embodiment. FIG. 18 is a front view of the retainingdevice. A retaining device 1B according to the embodiment shown in FIG.17 does not include the outer tube portion 4 and the finger member 14that are described in the first embodiment, and instead of the outertube portion 4 and the finger member 14, a second link section 15B and afinger member 14B are formed in the inner tube portion 3. Further, inthe embodiment, unlike the first embodiment, a connecting rod 6B havinga distal end connected to the second link section 15B is disposed in theinner tube portion 3. In addition, in the embodiment, unlike the firstembodiment, in addition to the lever 21 configured to advance andretract the connecting rod 6 described in the first embodiment in thecenterline direction of the inner tube portion 3, a manipulation unit(not shown) configured to advance and retract the connecting rod 6Baccording to the embodiment in the centerline direction of the innertube portion 3 is provided at the manipulation part 20. As shown inFIGS. 17 and 18, the second link section 15B converts advance andretraction motion of the connecting rod 6B into reciprocation motion ofthe finger member 14B to reciprocate the finger member 14B such that thefinger member 14B approaches or moves away from the first member 12. Inthe embodiment, the second link section 15B moves the finger member 14Bin a direction along a surface perpendicular to a plane on which theopening/closing motion of the first member 12 and the second member 13is performed.

In the embodiment, in the procedure of fastening together the firsttissue T1 and the second tissue T2, in the same sequence as the firstembodiment, like the first embodiment, after the first tissue T1 and thesecond tissue T2 are drawn such that the tissues are close to eachother, the tissues can be fastened together.

MODIFIED EXAMPLE 2-1

Next, a modified example of the embodiment will be described. FIG. 19 isa front view showing a configuration of the modified example of theembodiment. FIG. 20 is a front view showing another configuration of themodified example of the embodiment. FIG. 21 is a front view showingstill another configuration of the modified example of the embodiment.

As shown in FIG. 19, a movement direction of the finger member 14B withrespect to the first member 12 is not limited to the direction describedin the above-mentioned second embodiment. For example, the second linksection 15B may move the finger member 14B in a direction along asurface inclined with respect to the plane in which the opening/closingmotion of the first member 12 and the second member 13 is performed. Inaddition, in addition to the fact that the second link section 15Bapproaches or moves away from the first member 12, the second linksection 15B may reciprocate the finger member 14B to approach or moveaway from the second member 13.

As shown in FIG. 20, the retaining device 1B according to the embodimentmay include, in addition to the second link section 15B, a third linksection (not shown) configured to reciprocate a finger member 14C thatapproaches or moves away from the second member 13.

As shown in FIG. 21, the second link section 15B may move the fingermember 14B in a direction along a surface parallel to a plane on whichthe opening/closing motion of the first member 12 and the second member13 is performed to reciprocate the finger member 14B between a positionat which the finger member 14B comes in contact with the first member 12and a position at which the finger member 14B comes in contact with thesecond member 13. In this case, in a region in which the fastening ofthe tissue by the tissue fastening tool 30 is not disturbed, the secondlink section 15B supports the finger member 14B such that the fingermember 14B comes in contact with the surface different from the firstconnecting section 12 a among the outer surfaces of the first member 12and the finger member 14B comes in contact with the surface differentfrom the second connecting section 13 a among the outer surfaces of thesecond member 13. Accordingly, for example, when the second tissue isinserted between the first member 12 and the second member 13 after thefirst tissue is grasped by the first member 12 and the finger member14B, the first tissue and the second tissue can be fastened togetherwhile the first member 12 and the finger member 14B grasp the firsttissue.

Hereinabove, while embodiments of the present invention have beendescribed with reference to the accompanying drawings in detail, thespecific configurations are not limited to the embodiments, and mayinclude design changes or the like without departing from the sprit andscope of the present invention.

For example, as a means for fastening together a living body tissue, aclip, a stapler, or the like may be appropriately selected and employed.In addition, the inner tube portion 3, the outer tube portion 4, thetransmission portion 5, and the connecting rod 6 described in the firstembodiment may have flexibility. When the inner tube portion 3, theouter tube portion 4, the transmission portion 5, and the connecting rod6 have flexibility, and the insertion section 2 is flexible as a whole,the tissue can be closed from the lumen by causing the insertion section2 to pass through the treatment tool channel of the flexible endoscope.

The components shown in the above-mentioned embodiments and modifiedexamples may be appropriately combined and configured.

The present invention is not limited to the above-mentioned description,and is limited only by the accompanying claims.

What is claimed is:
 1. A retaining device comprising: a first member anda second member configured to grasp a first tissue and a second tissuedisposed separate from the first tissue; a third member configured to becapable of approaching and moving away from the first member and thesecond member; a support section configured to support the first member,support the second member so as to be movable relative to the firstmember such that the second member is capable of approaching and movingaway from the first member, and support the third member so as to bemovable relative to the first member such that the third member iscapable of approaching and moving away from the first member; and amanipulation part connected to the support section and configured tomanipulate the first member, the second member, and the third membersuch that the first member, the second member, and the third member moverelative to each other, wherein the first member and the third memberare capable of grasping the first tissue in a state in which the firsttissue is disposed between the first member and the second member, andbetween the first member and the third member, and the first member andthe second member are capable of grasping the first tissue and thesecond tissue such that the second tissue is disposed between the firstmember and the second member, and between the second member and thethird member to bring the first tissue and the second tissue in contactwith each other in a state in which the first member and the thirdmember grasp the first tissue.
 2. The retaining device according toclaim 1, further comprising: a tissue fastening tool having a firstpiece and a second piece configured to pinch the first tissue and thesecond tissue between the first member and the second member, the tissuefastening tool being configured to be implanted in a living body; afirst connecting section configured to connect the first piece and thefirst member such that the first piece is disposed at a side of thesecond member on an outer surface of the first member; and a secondconnecting section configured to connect the second piece and the secondmember such that the second piece is disposed at a side of the firstmember on an outer surface of the second member.
 3. The retaining deviceaccording to claim 2, wherein the manipulation part has a switching partconfigured to switch a connected state in which the first piece isconnected to the first connecting section and the second piece isconnected to the second connecting section, and a released state inwhich the first piece is spaced apart from the first connecting sectionand the second piece is spaced apart from the second connecting section.4. The retaining device according to claim 1, wherein the third memberis disposed at a position separate from positions of the first memberand the second member in a direction perpendicular to a direction inwhich the first member approaches or moves away from the second member.5. The retaining device according to claim 1, wherein the supportsection is configured to support the third member such that the thirdmember moves away from the second member as the third member approachesthe first member.
 6. The retaining device according to claim 1, whereinthe support section has: a first opening/closing section configured tosupport the first member and the second member such that the firstmember and the second member are capable of moving relative to eachother such that a moving direction of the second member with respect tothe first member becomes reciprocation movement in one predeterminedplane; and a second opening/closing section configured to support thethird member such that the third member is capable of moving relative tothe first member such that an abutting direction of the third memberwith the first member becomes a direction along a surface crossing theone plane.
 7. The retaining device according to claim 6, wherein thesecond opening/closing section reciprocates the third member between aposition at which the third member is adjacent to the second member anda position at which the third member is adjacent to the first member. 8.The retaining device according to claim 7, wherein the support sectionincludes: a first support body having a rod shape and configured tosupport the first member and the second member; and a second supportbody formed in a tubular shape through which the first support body isinserted, and configured to be rotatable with respect to the firstsupport body about a centerline of the first support body serving as arotational center, the third member being fixed to the second supportbody, wherein the second opening/closing section reciprocates the thirdmember between the position at which the third member is adjacent to thesecond member and the position at which the third member is adjacent tothe first member along a circumference about the centerline of the firstsupport body serving as a rotational center by a rotational motion ofthe second support body with respect to the first support body.
 9. Theretaining device according to claim 6, wherein the secondopening/closing section linearly moves the third member relative to thefirst member.